Age, knowledge, preferences, and risk tolerance for invasive cardiac care

Background/objectives: The extent to which individual knowledge, preferences, and priorities explain lower use of invasive cardiac care among older vs. younger adults presenting with acute coronary syndrome (ACS) is unknown. We directly surveyed a group of patients to ascertain their preferences and priorities for invasive cardiovascular care. Design: We performed a prospective cohort study of adults hospitalized with ACS. We surveyed participants regarding their knowledge, preferences, goals, and concerns for cardiac care, as well as their risk tolerance for coronary artery bypass grafting (CABG). Setting: Single academic medical center. Participants: Six hundred twenty-eight participants (373 <75 years old; 255 ≥75 years old). Measurements: We compared baseline characteristics, knowledge, priorities, and risk tolerance for care across age strata. We also assessed pairwise differences with 95% confidence intervals (CI) between age groups for key variables of interest. Results: Compared with younger patients, older participants had less knowledge of invasive care; were less willing to consider cardiac catheterization (difference between 75–84 and< 65 years old: −7.8%, 95% CI: −14.4%,-1.3%; for ≥85 vs. <65: −15.7%, 95% CI: −29.8%,-1.6%), percutaneous coronary intervention (difference between 75–84 and< 65 years old: −12.8%, 95% CI: −20.8%,-4.8%; for ≥85 vs. <65: −24.8%, 95% CI: −41.2%,-8.5%), and CABG (difference between 75–84 and< 65 years old: −19.0%, 95% CI: −28.2%,-9.9%; for ≥85 vs. <65: −39.1%, 95% CI: −56.0%,-22.2%); and were more risk averse for CABG surgery (p <.001), albeit with substantial inter-individual variability and individual outliers. Many patients who stated they were not initially willing to undergo an invasive cardiovascular procedure actually ended up undergoing the procedure (49% for cardiac catheterization and 22% for PCI or CABG). Conclusion: Age influences treatment goals and willingness to consider invasive cardiac care, as well as risk tolerance for CABG. Individuals' willingness to undergo invasive cardiovascular procedures loosely corresponds with whether that procedure is performed after discussion with the care team.